Home Health (HH) National Provider Survey (CMS-10688)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10688 Standardized Survey	Form and Instruction	New	Available
Form CMS-10688 Semi-Structured Interview	Form and Instruction	New	Available
Response to Public Comments - HH Survey.docx	Supplementary Document	Uploaded 2019-03-06	Available
HH Survey Response Crosswalk - 508.pdf	Supplementary Document	Uploaded 2019-03-06	Available
HH Survey Supporting Statement B-CLEAN-Revised V2.docx	Supporting Statement B	Uploaded 2019-06-28	Available
HH Survey Supporting Statement A - Revised V2.docx	Supporting Statement A	Uploaded 2019-06-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235214	Standardized Survey	Form and Instruction	New
235213	Semi-Structured Interview	Form and Instruction	New

ICR Details

OMB Control No: 0938-1364	ICR Reference No: 201903-0938-004
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Home Health (HH) National Provider Survey (CMS-10688)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/28/2019
	Date Received in OIRA: 03/21/2019
Terms of Clearance: OMB is approving this information collection request for a period of three years during which timeCMS will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved
Responses	1,040	0	0
Time Burden (Hours)	1,060	0	0
Cost Burden (Dollars)	123,448	0	0

---

Abstract: Section 1890A(a)(6) of the Social Security Act (the Act) requires that the Secretary of the Department of Health and Human Services (HHS) conduct an assessment of the quality and efficiency impact of the use of endorsed measures in specific Medicare quality reporting and incentive programs. The Act further specifies that the initial assessment must occur no later than March 1, 2012, and once every 3 years thereafter. The implementation of quality measures by CMS has led to positive gains in the use of evidence-based standards of care by providers. To ensure the nation continues to build on these gains, and to fulfill the requirements of Section 1890A(a)(6) of the Act for the assessment of the quality and efficiency impact of the use of endorsed measures in specific Medicare quality reporting and incentive programs, CMS has conducted three national assessments (published in 2012, 2015, and 2018.) This planned data collection activity was developed and tested as part of the 2015 and 2018 Impact Assessment Reports. The results from the proposed data collection will be publicly reported as part of the 2021 Impact Assessment Report and extends the prior reports by providing CMS with quantitative and qualitative data specific to the use of home health quality and efficiency measures, which will be used by CMS to improve the home health measurement program so that they achieve CMS quality goals

---

Authorizing Statute(s): US Code: 42 USC 1395aaa-1(a)(6) Name of Law: Quality and efficiency measurement
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 57490	11/15/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 6789	02/28/2019
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Semi-Structured Interview	CMS-10688, CMS-10688	Home Health Agency Qualitative Interview Guide
Standardized Survey	CMS-10688	HHA Survey Instrument

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,040	0	0	1,040	0	0
Annual Time Burden (Hours)	1,060	0	0	1,060	0	0
Annual Cost Burden (Dollars)	123,448	0	0	123,448	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

---

Annual Cost to Federal Government: $1,356,820

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/21/2019

---